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Purpose To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality. Methods The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents. A pre-specified secondary aim was to examine the factors associated with outcome. Analyses were restricted to patients (93.1 %) fulfilling ARDS criteria on day 1–2 who received invasive mechanical ventilation. Results 2377 patients were included in the analysis. Potentially modifiable factors associated with increased hospital mortality in multivariable analyses include lower PEEP, higher peak inspiratory, plateau, and driving pressures, and increased respiratory rate. The impact of tidal volume on outcome was unclear. Having fewer ICU beds was also associated with higher hospital mortality. Non-modifiable factors associated with worsened outcome from ARDS included older age, active neoplasm, hematologic neoplasm, and chronic liver failure. Severity of illness indices including lower pH, lower PaO 2 /FiO 2 ratio, and higher non-pulmonary SOFA score were associated with poorer outcome. Of the 578 (24.3 %) patients with a limitation of life-sustaining therapies or measures decision, 498 (86.0 %) died in hospital. Factors associated with increased likelihood of limitation of life-sustaining therapies or measures decision included older age, immunosuppression, neoplasia, lower pH and increased non-pulmonary SOFA scores. Conclusions Higher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS. Trial Registration: ClinicalTrials.gov NCT02010073.

INTRODUCTION This study aimed to identify distinct dementia risk profiles in middle‐aged adults with two or more potential dementia risk factors, to inform targeted prevention strategies. METHODS Cross‐sectional analysis of baseline sociodemographic, clinical, and dementia‐risk data from the HAPPI MIND trial. Dementia risk was assessed using the Australian National University Alzheimer's Disease Risk Index. Risk profiles were identified using latent class analysis (LCA). RESULTS Among 403 participants (mean age 56.4 ± 5.7 years, 62.5% female), the median number of dementia risk factors was 5.0; hyperlipidaemia (92.5%), low cognitive activity (72.5%), obesity (57.6%), and hypertension (52.7%) were the most prevalent. Several risk factors showed significant positive correlations. LCA identified three distinct classes: 1−High Cardiometabolic Burden; 2−High Behavioural and Psychosocial Risk; and 3−Low Risk with Healthy Behaviours. DISCUSSION The identified latent classes highlight heterogeneity of dementia risk profile in midlife. Tailored, multidomain interventions addressing each group's specific needs may improve dementia risk profiles and support broader health outcomes. Highlights Middle‐aged Australians who participated in the HAPPI MIND dementia risk reduction trial had a median of five modifiable risk factors. Significant positive correlations were observed between behavioral and clinical risk factors, such as depression, along with poor diet, social isolation, and smoking. Latent class analysis revealed three distinct profiles: High Cardiometabolic Burden; High Behavioral and Psychosocial Risk; and Low Risk with Healthy Behaviors. The findings suggest there is a need for personalized, multidomain prevention strategies tailored to individual risk profiles in primary care.

Objectives The study aims to understand the return to work (RTW) needs of young and middle‐aged people who have experienced a stroke and to contribute to the development of supportive RTW services. Design A qualitative study employing the phenomenological method. Participants Eleven young and middle‐aged people who have experienced a stroke participated in the study. Methods Semi‐structured in‐depth interviews were conducted and analysed using Colaizzi's 7‐step method to identify and categorize the RTW needs of participants. Results The analysis delineated four overarching thematic categories of RTW needs among the participants: self‐management needs, emphasizing the regulation of symptoms, health maintenance and recovery planning; social support needs, highlighting the significance of workplace accommodations, professional medical guidance, and emotional encouragement from companions and family; the need for information related to returning to work, which includes accessing resources on rehabilitation opportunities, labour rights and professional consultation services; and personal development needs, focusing on fostering self‐worth, identifying growth opportunities and acquiring new skills to adapt to changing professional demands. Conclusion The diverse and comprehensive needs of young and middle‐aged people who have experienced a stroke underscore the importance of multifaceted support from healthcare professionals. This support should encompass medical, psychological, informational and skill‐development aspects and should involve enhanced communication and collaboration with relevant stakeholders to facilitate a successful RTW. Patient or Public Contribution This study was designed without direct involvement from patients or the public in the development of the research question, the design of the study, or the conduct of the research. This decision was informed by the specific focus on qualitative experiences and perceptions of stroke survivors regarding their RTW journey, which relied heavily on personal narratives and subjective accounts collected through individual interviews. However, the insights gained from these narratives have been crucial in shaping the research outcomes, emphasizing the patient‐centred approach to understanding RTW barriers and facilitators. Reporting Method This study followed the SRQR checklist for qualitative studies as its reporting method.

It is an assumption that physically active adults lead an overall healthy lifestyle. To examine this assumption, we administered a cross-sectional, web-based survey to a sample of young-to-middle-aged US adults between 18 and 49 who self-reported participation in at least one recreational sporting event in the past month. Logistic regressions were conducted to examine demographic characteristics associated with cancer risk and protective behaviors. Gender was represented equally (N = 938), and the average age was 32 years (SD: 8.4). Most participants reported >three days of moderate- to high-intensity physical activity (79%), but not meeting fruit and vegetable consumption guidelines (78%). Many reported current tobacco use (32%), binge drinking at least once in the past 30 days (62%), and suboptimal sun protection use (67%). Participation in lifestyle-related cancer risk and protective behaviors varied based on age, sex, education, routine doctor visits, perceived overall health, health-information-seeking behavior (how participants obtained health information), or team-based sport participation in regression models. Future interventions should be tailored to address varied cancer risk profiles among even physically active adults to encourage multiple healthy behavior changes.

The influence of sugar consumption on the risk of colorectal cancer (CRC) remains controversial. Prospective cohort studies focusing on total and specific types of sugar intake among the Asian population who have different patterns of sugar intake sources than American and European populations are scarce. We intended to examine the association of sugar intake with CRC risk among middle‐aged adults in a Japanese large‐scale population‐based cohort study. The participants (42,405 men and 48,600 women) who were 45–74 years old and answered the questionnaire in 1995–1999 in the Japan Public Health Center‐based Prospective Study were followed up until December 2013. Total sugars, total fructose, and specific types of sugar intake were estimated using a validated 147‐item food frequency questionnaire and divided into quintiles (Q1–Q5). We used Cox proportional hazard regression models adjusted for potential confounders to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During the follow‐up, 2118 CRC cases (1226 men and 892 women) were identified. We did not observe any clear association between all types of sugar intake and an increased risk of CRC. Analyses by tumor sites yielded a positive association of total sugar consumption with rectal cancer in women (1.75 [1.07–2.87] for Q1 vs. Q5; p linear trend = 0.03), but no statistically significant trend was detected among men. Sugar intake was not associated with CRC risk in middle‐aged Japanese adults. However, for rectal cancer, the probability of an increased risk among women with a higher total sugar intake cannot be excluded.

The relationship between sex‐specific blood biomarkers and memory changes in middle‐aged adults remains unclear. We aimed to investigate this relationship using the data from the Framingham Heart Study (FHS). We conducted association analysis, partial correlation analysis, and causal dose–response curves using blood biomarkers and other data from 793 middle‐aged participants (≤ 60 years) from the FHS Offspring Cohort. The results revealed associations of adiponectin and fasting blood glucose with midlife memory change, along with a U‐shaped relationship of high‐density lipoprotein cholesterol with memory change. No significant associations were found for the other blood biomarkers (e.g., amyloid beta protein 42) with memory change. To our knowledge, this is the first sex‐specific network analysis of blood biomarkers related to midlife memory change in a prospective cohort study. Our findings highlight the importance of targeting cardiometabolic risks and the need to validate midlife‐specific biomarkers that can accelerate the development of primary preventive strategies.

Aim To understand the experiences of individuals who undergo LEA due to DFU after disability. Design A descriptive research design in qualitative research. Methods Semi‐structured interviews were used in this qualitative descriptive study. Eleven middle‐aged patients (45–59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed. Results Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self‐concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over‐focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision‐making.

This article presents a study that directly replicated the recently developed Balanced Time Perspective Scale (BTPS; J.D. Webster, 2011 ) and included middle-aged and older adults. Participants included 90 younger, 69 middle-aged, and 69 older adults who completed the BTPS and a measure of life satisfaction and happiness. A factor analysis replicated original findings with separate subscales for a past orientation and a future orientation obtaining simple structure (alphas = .94 and .95 respectively). A balanced time perspective predicted higher scores on both measures of well-being replicating the original J.D. Webster ( 2011 ) findings. A chi-square analysis indicated, as predicted, that the percentage of younger adults tended to be higher in the future-focused category, and the percentage of older adults tended to be higher in the past-focused category. Implications of a balanced time perspective on mental health over the life course are discussed.

Grip strength in midlife can predict physical disability in senior years. Recent evidence shows the critical role of nutritional status on muscle function. We aimed to elucidate whether adherence to a particular dietary pattern would be associated with abnormal muscle strength among middle‐aged people. In this cross‐sectional study, a semiquantitative Food Frequency Questionnaire was used to assess the dietary intake of 2781 participants in the Ravansar Non‐Communicable Chronic Disease (RaNCD) cohort. Major dietary patterns from 28 main food groups were extracted using principal component analysis. Binary logistic regression was used to determine the association between the tertiles of the major dietary patterns and muscle strength status. Two major dietary patterns were identified: the “mixed dietary pattern” that heavily loaded with fruits, vegetables, nuts, dairies, sweets, legumes, dried fruits, fish, red meat, butter, whole grains, natural juices, poultry, pickles, olive, industrial juice, egg, processed meat, and snacks and “unhealthy dietary pattern” that heavily loaded by fats, sugar, refined grains, soft drink, salt, organ meat, tea, and coffee. Adherence to the mixed dietary pattern (OR = 1.03, 95% CI = 0.8–1.33, P for trend = 0.77) and the unhealthy dietary pattern (OR = 1.01, 95% CI = 0.79–0.13, P for trend = 0.89) did not associate with abnormal muscle strength. This study suggests that the dietary pattern involving the consumption of healthy and unhealthy food does not have an effect on muscle strength in middle‐aged adults. We identified two major dietary patterns from data of participants in the Ravansar Non‐Communicable Chronic Disease (RaNCD) study. The first dietary pattern was “mixed” that heavily loaded with fruits, vegetables, nuts, dairies, sweets, legumes, dried fruits, fish, red meat, butter, whole grains, natural juices, poultry, pickles, olive, industrial juice, egg, processed meat, and snacks and the second dietary pattern was “unhealthy” that heavily loaded by fats, sugar, refined grains, soft drink, salt, organ meat, tea, and coffee. Surprisingly we found that adherence to the mixed dietary pattern and the unhealthy dietary pattern did not associate with abnormal muscle strength.

Whereas a vast amount of research has demonstrated the association between core self-evaluations (CSE) and well-being indicators, few studies have specifically focused on the ways in which CSE might facilitate an increased well-being. This study assesses whether perceived stress might either be a potential mediator and/or moderator in the relationship between CSE and life satisfaction in two independent samples: middle-aged adults (N = 320) and young adults (N = 473). In both samples, participants completed a battery of questionnaires composed of a CSE scale, perceived stress scale and life satisfaction scale. Bootstrap analyses showed that perceived stress partially mediated the relationship between CSE and life satisfaction in both samples. However, moderation analyses failed to support that perceived stress moderated the influence of CSE on life satisfaction either in middle-aged adults or young adults samples. The implications of these findings for research and practice are discussed.